For example, abiraterone might be less preferable in a patient with diabetes who has poor glycaemic control because of the need for concomitant steroids. Active surveillance for prostate cancer: A narrative review of clinical guidelines. Carter HB, Helfand B, Mamawala M, et al. It makes recommendations on how best to support men in making an informed decision for or against PSA testing and on which testing protocol to recommend to men who decide in f… more confidence, whether the elevated PSA is more likely to be associated with prostate cancer than be due to non-cancerous changes, potentially avoiding unnecessary biopsy. The aim of this article is to review important changes in prostate cancer diagnosis and management over the past five years, particularly as they pertain to general practice. The reported negative predictive value of MRI is high, with median values of 82.4% for any prostate cancer and 88.1% for clinically significant prostate cancer,14 although the confidence intervals are quite wide. Eur Urol 2018;73(6):818–21. doi: 10.1038/nrurol.2015.313. Diabetes is a national health priority. A total PSA threshold of 4.0 ng/mL has traditionally been used as the criterion for prostate biopsy. Early reports suggested that detection of a particular splice variant of the androgen receptor (ARv7) in circulating tumour cells may identify patients who are resistant to androgen signalling–targeted inhibitors.30 However, this process has produced mixed results in validation studies31 and is not widely used clinically. doi: 10.1056/NEJMoa1506859. JAMA 2018;319(18):1914–31. The Royal Australian College of General Practitioners (RACGP) recommends against PSA screening, but acknowledges that the PSA debate remains unclear and open to individual interpretation. Eur Urol 2017;72(2):177–88. Prostate specific antigen is tissue-specific but not cancer-specific. A systematic review and meta-analysis from the European Association of Urology prostate cancer guidelines panel. Privacy | Terms of use, Experiences in a remote emergency department, Professional and legal obligations in Australia, Patients’ knowledge, attitudes and experiences, Prevalence in diabetic retinopathy screening, download the MS Word Viewer free of charge, Wikipedia: Comparison of reference management software. Prostate specific antigen (PSA) is a glycoprotein produced solely by the prostate. Early detection with molecular imaging may allow these sites to be specifically targeted with local treatment, thus avoiding or delaying the need for systemic therapy. The pre-employment medicalNuisance or great opportunity? In asymptomatic men without a diagnosis of prostate cancer, a single total PSA test result above 3.0 ng/mL identifies three-to-four times as many men who do not have prostate cancer on … 1 doi: 10.1056/NEJMoa040720. There is also interest in the use of PSMA-PET (CT or MRI) as a primary staging modality for patients with intermediate- and high-risk disease prior to definitive local therapy (replacing the standard staging CT and bone scan), with early evidence suggesting greater sensitivity.20 It is currently not funded for this indication, although this may change if prospective comparative studies are positive.21. N Engl J Med 2019;381(1):13–24. 2 Moll et al described five types of PsA, namely oligoarticular asymmetrical arthritis, symmetrical polyarthritis, distal arthritis, arthritis mutilans and spondyloarthropathy (which can affect the spine and sacroiliac joints). within, or mailed with, Australian Family Physician is not necessarily endorsed by the publisher. Clinical practice guidelines PSA Testing and Early Management of Test-Detected Prostate Cancer (link is external) Mesh Headings: Prostate-Specific Antigen | Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MG. doi: 10.1016/j.eururo.2017.01.042. It can help to diagnose and monitor prostate disease. Currently, a single demarcation between normal and elevated PSA values, 4.0 ng/mL, is used as an indication for biopsy among men of all ages. Its function is to liquefy semen. In partnership with Cancer Council Australia and a multi-disciplinary expert advisory panel comprising urologists, radiation oncologists, pathologists, general practitioners, medical oncologists, epidemiologists, allied health professionals and consumers, Prostate Cancer Foundation of Australia has developed national evidence-based clinical practice guidelines on … Prostate Cancer. To view these documents you will need software that can read Microsoft Word format. PSA as a screening test to diagnose prostate cancer. Germline genetic testing in advanced prostate cancer; practices and barriers: Survey results from the Germline Genetics Working Group of the Prostate Cancer Clinical Trials Consortium. inaccuracies contained therein or for the consequences of any action taken by any person as a result of Urol Oncol 2015;33(1):17.e1–17.e7. General Identification of germline mutations has significant implications for the families of patients, as this DNA is passed on to children. This changed in 2004 when the taxane chemotherapeutic agent docetaxel was reported to prolong survival for patients with metastatic CRPC.23 This has been followed by the approval of a slew of new systemic agents over the past 15 years, all of which are administered in combination with ADT and have been shown to improve survival,24 further increasing the therapeutic options available to patients (Table 1). Eur Urol Focus 2019;pii: S2405-569(19):30159–2. What Is the negative predictive value of multiparametric magnetic resonance imaging in excluding prostate cancer at biopsy? A PSA test measures the amount of PSA in the blood. doi: 10.1056/NEJMoa1315815. doi: 10.1016/j.euf.2019.06.004. anything contained in this publication. The rate of change in PSA levels, referred to as PSA velocity, has been studied as a marker for the presence of prostate cancer. This article gives an overview of the main points in these new guidelines on PSA testing. doi: 10.1016/j.eururo.2018.09.021. Available at www.prostate.org.au/media/612113/PSA-Testing-Guidelines.pdf [Accessed 7 February 2020]. Journal of Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. One advantage of visualising areas of abnormality prior to biopsy is that these areas can be specifically targeted, reducing the sampling error inherent in systematic biopsies. Palma DA, Olson R, Harrow S, et al. Patients should be aware that testing may have insurance implications, highlight the risk of other cancers (that the patient may not anticipate) and identify variants of unknown significance that require ongoing follow-up in case they are revealed to be important at a later date. Before ordering a PSA test, health practitioners should talk to men about the potential benefits and harms of PSA testing. Eur Urol 2016;69(3):419–25. Australian Prostate cancer accounted for the second highest number of male cancer deaths in Australia. Valerio M, Donaldson I, Emberton M, et al. Eur Urol 2019;75(1):88–99. N Engl J Med 2018;378(19):1767–77. The prostate specific antigen (PSA) test is a commonly used blood test to detect potential prostate cancer, but elevated PSA levels do not necessarily mean cancer is present. The Royal Australian College of General Practitioners (RACGP) recommends against PSA screening, but acknowledges that the PSA debate remains unclear and open to individual interpretation. The current trend towards the use of lower total PSA thresholds (e.g. Another area of ongoing interest is the concept of oligometastatic disease, which is well established in other tumours and posits that some patients with a limited number of metastases (<3 or <5, depending on the author) may represent a ‘curable’ metastatic state. If you do not have it you can download Adobe Reader free of charge. J Clin Oncol 2019;37(32):2974–86. doi: 10.1200/JCO.19.00799. N Engl J Med 2015;373:737–46. The results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood. doi: 10.1016/S0140-6736(15)01037-5. N Engl J Med 2017;377(4):352–60. Tannock IF, de Wit R, Berry WR, et al. necessarily those of the publisher or the editorial staff, and must not be quoted as such. Diagnostic pathway with multiparametric magnetic resonance imaging versus standard pathway: Results from a randomized prospective study in biopsy-naive patients with suspected prostate cancer. Armstrong AJ, Szmulewitz RZ, Petrylak DP, et al. The PSA testing guidelines published by the Prostate Cancer Foundation of Australia/Cancer Council Australia (and endorsed by the National Health and Medical Research Council) contain detailed information about who should be offered PSA testing and the supporting evidence.4 In brief, for men at average risk of prostate cancer with a reasonable life expectancy (>7 years) who have been informed of the benefits and harms of testing and have decided to proceed with regular testing, PSA testing should be offered every two years between the ages of 50 and 69 years, with further investigation offered if the PSA exceeds 3.0 ng/mL (typically an early repeat PSA with a free/total ratio in the first instance). Eur Urol 2017;72(2):282–88. Prebiopsy multiparametric magnetic resonance imaging for prostate cancer diagnosis in biopsy-naive men with suspected prostate cancer based on elevated prostate-specific antigen values: Results from a randomized prospective blinded controlled trial. Although a systematic template biopsy is usually performed at the same time as targeted cores are taken, there has been some debate as to whether this is required. Prostate cancer is a common tumour type in Australian men. Available at https://uroweb.org/guideline/prostate-cancer/ [Accessed 7 February 2020]. Active surveillance aims to defer curative treatment for patients with low-risk, clinically localised prostate cancer to minimise treatment-related toxicity without compromising survival. Prostate Cancer Foundation of Australia and Cancer Council Australia. 8 This … The PSA testing guidelines published by the Prostate Cancer Foundation of Australia/Cancer Council Australia (and endorsed by the National Health and Medical Research Council) contain detailed information about who should be offered PSA testing and the supporting evidence. ARCHES: A randomized, phase III study of androgen deprivation therapy with enzalutamide or placebo in men with metastatic hormone-sensitive prostate cancer. doi: 10.1056/NEJMoa1704174. To SQ, Kwan EM, Fettke HC, et al. 3.0 ng/mL), in place of 4.0 ng/mL or thresholds based on age-related normal values, has the potential to increase the number of prostate biopsies performed. Patients who harbour germline defects in genes involved in the repair of DNA damage (such as BRCA2) are at an increased risk of developing certain cancers, including prostate cancer, when compared with patients without defects. It employs a predefined program of regular monitoring (with PSA, DRE and repeated biopsy) to allow for delayed intervention at a stage when the disease is still potentially curable. N Engl J Med 2014;371(11):1028–38. Where To Download Racgp Guidelines type 2 diabetes. Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: A systematic review and meta-analysis. The management of prostate cancer has changed significantly in recent years, particularly the use of imaging, with the introduction of prostate magnetic resonance imaging as routine in the diagnostic pathway, and the increasing use of prostate-specific membrane antigen positron emission tomography for early stratification in the salvage setting for failure of primary treatment in localised disease. 7 The Prostate Cancer Foundation of Australia and Cancer Council Australia guidelines from 2016 recommend PSA testing every two years for men aged 50–69 years at average risk of prostate cancer. 1 Therefore, GPs have no obligation to offer prostate cancer screening to asymptomatic men. Australian Family Physician (incorporating Annals of General Practice) The evaluation identified five relevant systematic reviews, which included a total of six randomised controlled trials doi: 10.1056/NEJMoa1903307. doi: 10.1016/j.eururo.2015.05.024. Articles in the December issue discuss various health issues affecting school-aged children, including acne, eczema and growth disorders. Expression of androgen receptor splice variant 7 or 9 in whole blood does not predict response to androgen-axis-targeting agents in metastatic castration-resistant prostate cancer. College of General Practitioners (RACGP) recommends against PSA screening, but acknowledges that the PSA debate remains unclear and open to individual interpretation.7 The Prostate Cancer Foundation of Australia and Cancer Council Australia guidelines from 2016 recommend PSA testing every two years for men aged 50–69 years at average risk PSA is mostly found in semen, but it is also normal to find small amounts of PSA in the blood of healthy men. Its function is to liquefy semen. effectiveness of prostate-specific antigen (PSA) testing of asymptomatic men in reducing mortality and morbidity from prostate cancer5. doi: 10.1016/j.eururo.2016.08.041. Nat Rev Urol 2016;13(3):151–67. Available at www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-MRIProstate [Accessed 7 February 2020]. Porpiglia F, Manfredi M, Mele F, et al. The guidelines were published in January following the National Health and Medical Research Council (NHMRC) approving the guidelines’ recommendations. doi: 10.1016/j.eururo.2018.03.028. There have been significant changes in how prostate cancer is diagnosed and managed in the past five years, with the introduction of new clinical pathways that were unprecedented just a decade previously. PSA screening is a controversial issue as the RACGP guidelines do not recommend PSA screening. Pritchard CC, Mateo J, Walsh MF, et al. Lancet 2016;387(10024):1163–77. In addition, upfront combinations of androgen deprivation therapy with other systemic treatments have yielded significant gains in overall survival for patients with metastatic disease. DOC Some documents on this site are in Microsoft Word format. Given that recurrent disease can be detected biochemically often well before it is identifiable radiologically by CT or bone scan, treatment decisions regarding who should proceed with salvage are often imprecise, with many patients exposed unnecessarily to the morbidity of treatment without any therapeutic benefit. (PRECISION) study allowed 28% of men to avoid a biopsy, but oncological outcomes have yet to be reported to indicate if this approach is safe in the long term.12 Introduction of an MRI-based triage system to prostate biopsy into one Australian public teaching hospital resulted in 47% of men avoiding biopsy altogether, with clinically significant cancers being diagnosed in 60.5% of men with a ‘positive’ MRI, and considerable savings from a healthcare perspective.15 At this stage, MRI is not recommended as an initial screening tool. 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